The cognitive and behavioral effects of heavy prenatal alcohol exposure are devastating to the individual, their families, educators, and society. However, treatment of these effects remains understudied and many questions remain unanswered. Three decades of research have clearly documented that prenatal alcohol exposure causes cognitive dysfunction. In contrast, little empirical evidence exists on treatment efficacy in this population. Among the most significant of the cognitive effects in these children are those involving attention deficits. Attentional problems are known to respond to treatment in other populations, as in children with attention deficit-hyperactivity disorder (ADHD). About 65 percent of children with ADHD respond to stimulant treatment. Stimulant medication is used with children with histories of prenatal alcohol exposure, but its effectiveness has not been studied empirically. We will evaluate how many children with heavy prenatal alcohol exposure show a positive response to treatment with methylphenidate, a stimulant commonly used in the treatment of ADHD. Effectiveness will be measured using a paired-associate learning paradigm and parent and teacher rating scales. Second, anecdotal evidence suggests that a sizeable minority of alcohol-exposed children will not respond favorably to methylphenidate. At this point, it is not known whether an individual child will be a positive or adverse responder and the pharmacological treatment of these children is often done on a trial-and-error basis. We will assess the ability of neuropsychologic, neuroanatomic, and psychiatric variables to predict either positive or adverse response to methylphenidate in children with heavy prenatal alcohol exposure. Measures of attention/executive function and other neuropsychologic variables, psychiatric diagnosis, family adversity status, and size measures of brain structures affected by heavy prenatal alcohol exposure will be included. Knowledge gained from this research will help to provide a more rational basis for the treatment of the well-documented attentional problems in these children.